Individual
KATHRYN L GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
218 N. PINE STREET, HALFWAY, OR 97834
(417) 425-0235
(541) 742-7210
Mailing address
PO BOX 647, HALFWAY, OR 97834-0647
(541) 742-5023
(541) 742-7210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-00542
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500648623
—
OR
Enumeration date
04/10/2007
Last updated
05/17/2021
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